“Admitting to belief in God and having Christian faith is currently regarded as a taint, revealing that one’s sanity is impaired”. This is the starting point of Andrew Sims’s exploration of the relation between religion and mental health and his critique of Richard Dawkins’s “The God Delusion”. He thoroughly justifies the books more positive subtitle, “Why religion is good for your health”.
237 pp. Continuum Books. To purchase this book online, go to www.continuumbooks.com
CONTENTS
Foreword by Alister McGrath
Preface
Acknowledgements
Index
CHAPTER ONE
‘PSYCHE’ MEANS MORE THAN MIND
I am not aware that there was ever any hostility between religion and psychiatry
Senior consultant psychiatrist 2008
All religious people are psychotic
Consultant psychiatrist 2000
The two statements above are by doctors working with the mentally ill in the first decade of the twenty-first century and they reveal the substance of why this book has been written. For many mentally-ill people, their religious belief is vitally important to them but they have found that mental health professionals have either ignored or attacked it. They feel that by having their religious aspiration denied they had been dehumanized. This book aims to vindicate them.
Speak up for those who cannot speak for themselves
Speak up for those who cannot speak for themselves,
for the rights of all who are destitute.
Speak up and judge fairly;
defend the rights of the poor and needy (1).
When I entered psychiatry as a young medical graduate, I expected my Christian faith to be consonant with my professional practice. The antagonism I sensed towards faith from the psychiatric establishment at that time was quite contrary to this; the historical reasons for this attitude are traced in Chapter 3. I was motivated by my beliefs when starting to train as a psychiatrist to ‘speak up for those who could not speak for themselves’. I had been intrigued by the enigma of what made people do the things they do since before becoming either a medical student or a Christian. The range of diverse opinions in psychology and psychiatry fascinated me. In the years that followed my change from thinking of myself as an atheist to becoming a Christian at the age of 18, I gradually became convinced that I wanted to practise my Christian faith as a psychiatrist. My conviction (which was never a perception nor, since it was always amenable to reason, a delusion) felt to me then like a vocation – a ‘call from God’ – of the type which motivates others to join the Church or become a missionary.
It seemed reasonable to put my interests and experiences together and train for psychiatry, but I also knew that the atmosphere within psychiatry towards religious belief was not neutral but hostile and many within the Church harboured a deep distrust of psychiatry. There was profound misunderstanding and consequent antipathy in Britain between the institutions of psychiatry and the Christian Church.
Characters in a tragedy: patients, pilgrims, psychiatrists
This book is not primarily concerned with arid, academic disciplines such as theology or psychiatry but with people and how they interact with communities. The unhealthy situation in which psychiatry denies the significance, and even existence, of soul or spirit has led religious people to have a profound distrust of psychiatry and been disastrous for all those involved. They are like characters in a dramatic tragedy: patients with or without religious convictions; religious leaders and all those with religious beliefs; psychiatrists and religious others involved professionally or in a voluntary capacity with mental health services. Out of this labyrinth of misunderstandings, it is always the patients who suffer most and who are caught in the crossfire.
Although both psychiatrists and religious leaders share the intention to help people, even the language they use is misconstrued by each other. This situation is a drama because the principals find it almost impossible to play out of role, and a tragedy because all suffer from the conflict, but especially the patients.
The relationship between psychiatry and belief affects these three different groups of people: those who suffer some form of psychiatric condition, patients; those who have a belief, whom I will designate pilgrims as being less pejorative and less capable of misunderstanding than religious people; and mental health professionals – psychiatrists in short.
Of course, any individual may be in more than one group, perhaps even all three. A fourth group, the general public, are likely to have decided, divided, often prejudiced and antipathetic views about each: ‘the mentally ill are dangerous, ‘religious people are hypocrites’, ‘psychiatrists are quacks’. These three parties and how they interact will stay with us from now onwards.
The second diagnosis: medicine of the person
Many doctors have tried to practise what they construed as rational, organic medicine, basing their diagnosis solely on the signs of illness they can observe and on their knowledge of gross and cellular pathology. They have found that this does not always work.They often need to make a ‘second diagnosis’ which takes into account aspects of the whole person not included within disturbed chemistry; physiology and anatomy.
Paul Tournier was a Swiss physician involved in general practice and psychotherapy; he applied Christian faith and Biblical insights throughout his working life and in his copious writings from 1940 until his death in 1986. He had a profound influence upon several generations of students, including on my own life and psychiatric practice. He published Médecine de la Personne in 1940 and became the founder of an international movement with that title. Its ethos was that the person, or ‘whole person’, should include physical, mental and spiritual aspects. In all his dealings with other people he emphasized the personal and valued them as individuals. A recent appreciation of his work and writings has reappraised their influence on the current practice of medicine internationally (2). Paul Tournier wrote:
The second diagnosis, on the other hand, is subjective. It is the patient himself, never the doctor, who can make it through the impulse of his inmost conscience. We in our turn can help him to establsh this diagnosis, but here again passively; that is to say, not by suggesting a diagnosis to him, but through the climate of spiritual fellowship that we offer him.
From the point of view of the patient’s eternal destiny, the second diagnosis is much more important than the first. But from the strictly medical point of view they are of equal importance (3).
If this need to consider the whole person is true for the physician or general practitioner, it is even more so for the psychiatrist, but in the past psychiatrists have neglected it, despite the nature of their work:
Psychiatrists concern themselves with human mental suffering. Behind the consulting room door they reflect with their patient on questions of meaning and existence, issues that concern philosophy and religion as much as psychiatry. It is striking, therefore, that psychiatrists regard spirituality and religion as, at best, cultural noise to be respected but not addressed directly or at worst pathological thinking that requires modification (4).
This emphasis upon spiritual issues might be seen to be more appropriate for ministers of religion than doctors; there are certainly some similarities in their work, but also profound differences. A Canadian medical student wrote: ‘When I came to university, on alternate weeks I wanted to be a rabbi or a doctor… Both professions pursue justice and well-being for vulnerable people; both are devoted to working in partnership with people in the community to bring about healing, personal growth, and responsible societies (5). Unfortunately failing to understand the validity of each other profession’s point of view, clerical or medical, has had devastating effects most often upon that innocent third party – the patient.
A humane aspiration for the psychiatrist was expressed by Jean Colombier, a physician working with the mentally ill in Paris in the eighteenth century: ‘It is to the weakest and most unfortunate that society owes most diligent protection and care’ (6). A colleague of mine has spent his professional career looking after people with severe learning disabilities, which used to be called mental subnormality. He works with total dedication. It is very rare for him to vet more than a smile of thanks from any patient – most of them have considerable limitations with communication. ‘Job satisfaction’ comes from knowing that he is doing what he should be doing before God. Psychiatry aims to alleviate the suffering and improve the mental, physical and social functioning of those whom it is called upon to treat.
The private face of psychiatry is to succour, support and treat individual sufferers. The mentally ill are among the poorest and most deprived in every community, and in many societies almost without rights. For example, in Nepal in 2007, showing overt signs of severe mental illness outside the home, without any other disturbed or violent behaviour, could still result in imprisonment rather than hospitalization. The public face of psychiatry is to promote the interests of the mentally ill with government, with all organizations responsible for health care, and with the general public. This is in complete accord with Christian belief.
After a long campaign, we are finally agreed as doctors that there is both a physical and psychological element in all illness. Now, we need to add spiritual aspects of health to our medical consideration. We psychiatrists regularly complain when our medical colleagues cannot get beyond the physical, even when evidence for a psychosocial cause is quite blatant, but we may be guilty of an equivalent error in almost totally excluding spiritual considerations from the way we understand our patients (7). Traditionally, patients have been asked on admission to hospital to give a one-word answer for their ‘religion’; we have neglected the much more important question,’what does your religion and your faith mean to you?’ An irate consultant, treating a severely-ill child from a Muslim family who had failed to attend for an outpatient appointment, complained, ‘And it was only because the family were celebrating Eid.’
The hope of the believer, whether Jewish, Muslim or Christian, has been expressed:
Those who trust in the Lord are like Mount Zion,
which cannot be shaken but endures for ever (8).
However, many have claimed that this hope is ill-founded, some stating that it is false, and some, going further, with the claim that belief is evidence of ‘madness’ – it is a delusion. In the distant past, the word delusion could refer to being fooled or cheated (9), but in modern speech it always implies the suspicion of psychiatric illness. Is every person with religious conviction suffering from some form of overt or covert mental illness? Since Sigmund Freud stated that belief in God was delusional, many have followed in his wake.
To answer the question, ‘is faith delusional?’ we must look both at psychiatry, mental illness and the manner in which symptoms are expressed, and also at spirituality, religion, faith and what that means for the individual believer, especially the person who becomes mentally ill. The particular part of psychiatry concerned with the precise identification of abnormal phenomena, such as delusion, in mental illness is called descriptive psychopathology. I claim a right to give an opinion, as my book on descriptive psychopathology, Symptoms in the Mind, now in its 4th edition in English, and translated into several other languages, is the standard text for psychiatric trainees in the British-influenced world (10).
Every non-medical reader will be relieved to know that even doctors do learn from their mistakes. A medical teacher in the 1960s said: ‘Don’t talk to me about psychological causes, we will eventually find a pathological or physiological explanation for all diseases’. There used to be philosophers and psychologists who denied the existence or the concept of mind, let alone spirit.
Body and mind: is this mental or physical?
Psychiatry was suffering in the 1960s from a severe outbreak of Cartesian dichotomy, with the equally perilous consequences of either a mindless or brainless pschiatry (11). Clinicians would make a distinction into either a physical or mental disease which was supposed to manifest either somatic or psychological symptoms.
Most doctors have now got beyond assuming that all ‘real’ illness arises solely from organic pathologic. General physicians, mostly, now accept psychological factors as being important for cause; most psychiatrists consider mental illness as being both physical and mental in causation and treatment.
Disease or illness is a social construct. A philosopher who was deeply interested in health and illness, Peter Sedgwick, wrote: “All departments of nature below the level of mankind are exempt both from disease and from treatment – until man intervenes with his own human classifications of disease and treatment. The blight that strikes at corn or at potatoes is a human invention, for if man wished to cultivate parasites (rather than potatoes or corn) there would be no ‘blight, but simply the necessary foddering of the parasite-crop’ (12). Thus, because we want to grow potatoes we categorize potato blight as ‘disease of potatoes’.
The distinction between physical and mental illness is thoroughly unhelpful. A middle-aged man complained of discomfort in his stomach, feeling sick, trembling of his fingers and problems at work. A medical student, asked by a psychiatrist to comment on his history, asked the question, ‘Is this a mental or physical condition?’ thereby demonstrating that he had lost the plot: alcohol dependence is undoubtedly both mental and physical and making this arbitrary distinction endangers the future care of the patient. Robert Kendell wrote: ‘Not only is the distinction between mental and physical illness ill-founded and incompatible with contemporary understanding of disease, it is also damaging to the long-term interests of patients themselves’ (13). Doctors should try and get away from seeing a flow-chart in their minds that sends ‘physical’ and ‘mental’ in different directions.
Every physical illness also has psychological aspects; this includes diabetes, bronchopneumonia, hypothyroidism and lumbar disc protrusion. They all have organic pathologies, and all have psychological consequences. Most mental illnesses manifest physical symptoms: depressive disorder, generalized anxiety disorder and schizophrenia will appear in any psychiatric classification, yet each of them is associated with physical manifestations. Conditions such as anorexia nervosa and alcohol dependence are clearly both physical and mental; they require psychiatric management and sometimes medical as well. Much of my early research was in this area; among my findings was the unfortunate fact that those with serious and long-lasting emotional disturbance die at a significantly earlier age than the general population.
The cure of souls: ‘I’m sorry to talk about God, but …’
Whereas most patients with psychiatric disorders come to the doctor looking for a lasting cure, most doctors have a more prosaic ambition to do the best they can, applying their professional knowledge and skill for the benefit of this individual sufferer. A supercilious medical teacher once said, ‘Remember, doctors never cure patients. They may alleviate their symptoms, maintain their vital systems while they themselves make a recovery, remove a defective organ, make good a deficiency, and so on. It is only bacon manufacturers who cure.’
The ‘cure of souls’, as an objective, would hardly raise an eyebrow in some ecclesiastical circles (it is still the term used by a bishop licensing any priest to a new job: ‘Receive this cure of souls: it is both thine and mine . . .’), but would be regarded as quite outrageous by many psychiatrists; words and ideas can change their meaning in different contexts. The three different groups of people – patients, pilgrims and psychiatrists – would have quite different understandings of this phrase. As if these misunderstandings were not complicated enough already, within each of these three groups there will be those with widely differing views, implacably opposed to each other.
Religious people and psychiatrists sometimes appear to live in different worlds from each other – and they know that they do. Patients are put in an uncomfortable position in the middle. Patients also have distinctive beliefs and values; they know that the psychiatrist will not necessarily share these, and they feel both dependence upon and vulnerability towards the psychiatrist – ‘He or she has what I, the patient, need’. This is a dilemma – both for patient and psychiatrist. This was tellingly highlighted by a patient who, in explaining his current difficulties, interrupted the history, to say with obvious embarrassment: ‘I’m sorry – to talk about God, but . .
In some psychiatric papers the importance of religion and spirituality for mental health, and also the difficulty of integrating these concepts into scientific medicine, is made out to be irresolvable. Psychiatric tradition and training may over-emphasize the ‘religiosity’ gap between doctors and patients and this may increase the failure in communication (15).
In considering misunderstandings that occur, we need to look at the aims of the professional groups – ministers of religion and psychiatrists. The expression, cure of souls, might be used by a somewhat old-fashioned priest as a description of his work with individuals. More likely, ministers would say that they are trying to help people in any possible and available way in the context of God being in the world, being involved in this individual’s affairs, knowing about ‘each hair of the person’s head’, and having established a plan for life. Psychiatrists, as doctors, are concerned for the well-being of their patients. They work to a model of treating psychological pain, and minimizing the loss of their ability to function adequately. It is noteworthy that neither profession has as its ultimate aim solely to do the bidding of its parishioners/patients: to do them good, especially long-term – yes; to attempt to treat the root causes of malaise – yes; to relieve pain, suffering and disability – yes; to do just what is asked for, irrespective of the consequences – no.
Why does this matter for patients? The task for mental health carers
Many patients acknowledge the significance of religious faith in their lives and this has often become more important for them when they recognize themselves as being ill. Prince Charles, Prince of Wales, addressing psychiatrists about their work, spoke eloquently on behalf of patients: I believe that the most urgent need for Western man is to rediscover that divine element in his being, without which there never can be any possible hope or meaning to our existence in this Earthly realm’ (16).
The need for mental health professionals to take spiritual aspects of their patients into account and not to neglect them, has been robustly made by John Swinton (17):
The task then for mental health carers is to develop a new role as spiritual healers. Such a role will involve the development of modes of being and methods of care that can inject meaning, hope, value and a sense of transcendence into the lives of people with mental health problems even in the midst of conditions that frequently seem to strip them of even the possibility of such things.
Our patients are apprehensive concerning the hostility psychiatry has shown in the past towards their religious beliefs. They want psychiatrists to recognize the significance of their religious faith and integrate it into the treatment plan. They do not want their belief’s to be belittled or denied. Mental health service users themselves have recommended very strongly that their treating professionals acknowledge the spiritual aspects of mental health and its problems (18).
Many of the general public, including those who subsequently become patients, have a deep, almost superstitious fear of psychiatrists: ‘They can read your mind, you know’. That belief is, of course, completely unfounded, but the myth persists. It reminds me of a recurring fantasy I had as a child that there was a window in the back of my neck through which anyone behind me could see the thoughts in my mind. Not a pleasant idea!
A woman in her thirties, a convinced Christian and a member of a church with traditional views on morality, had to be admitted to a psychiatric ward. A male patient persistently pestered her sexually on her ward. When she became distressed by this and appealed to the staff to protect her, she felt that they did not support her. Her major complaint to her minister, and thence to a sympathetic doctor, was that the staff were not able to understand why she should have moral objections to a sexual relationship, and attributed these to her illness. Such examples, insensitively ignoring the patient’s beliefs and values, have unfortunately not been uncommon from mental health professionals over many decades.
NOTES
